How The Affordable Care Act Impacts Medicare, Medicaid

Image Credit: MGN Online

Image Credit: MGN Online

The Affordable Care Act’s new health insurance marketplaces are now up and running. The exchanges will allow Americans without insurance, or those unhappy with current coverage options to buy private plans at a variety of price points.

Unlike many states, Alabama has opted not to set up its own exchange, so residents will need to purchase through the federally-facilitated exchange at Healthcare.gov. Click here to get started exploring your plan options.

Many people have questions about how the new marketplaces, and ObamaCare in general, will impact Medicare and Medicaid. Here’s some basic information, excerpted from the government websites for those programs.

Medicare

Per the Medicare.gov website, here are the “top five things you need to know” about the Affordable Care Act (ACA) if you have Medicare:

“Your Medicare coverage is protected. Medicare isn’t part of the Health Insurance Marketplace established by ACA, so you don’t have to replace your Medicare coverage with Marketplace coverage.  No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you’ll still have the same benefits and security you have now.

You don’t need to do anything with the Marketplace during Open Enrollment.You get more preventive services, for less. Medicare now covers certain preventive services, like mammograms or colonoscopies, without charging you for the Part B coinsurance or deductible. You also can get a free yearly “Wellness” visit.

You can save money on brand-name drugs. If you’re in the donut hole, you’ll also get a 50% discount when buying Part D-covered brand-name prescription drugs. The discount is applied automatically at the counter of your pharmacy—you don’t have to do anything to get it. The donut hole will be closed completely by 2020.Your doctor gets more support. With new initiatives to support care coordination, your doctor may get additional resources to make sure that your treatments are consistent.

The ACA ensures the protection of Medicare for years to come. The life of the Medicare Trust fund will be extended to at least 2029—a 12-year extension due to reductions in waste, fraud and abuse, and Medicare costs, which will provide you with future savings on your premiums and coinsurance.”

Read more at Medicare.gov.

Medicare

“The Affordable Care Act actually refers to two separate pieces of legislation — the Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) — that, together expand Medicaid coverage to millions of low-income Americans and makes numerous improvements to both Medicaid and the Children’s Health Insurance Program (CHIP).”

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If you are interested in the law as a whole, you can:

Read the Compilation of the Affordable Care Act, or
Review the law by section

Descriptions of all of the major Medicaid and CHIP-related provisions of the Affordable Care Act as well as related policy guidance can be found below. You can also find program information by state at Medicaid.gov.

AFFORDABLE CARE ACT PROVISIONS

DESCRIPTION

Eligibility Fills in current gaps in coverage for the poorest Americans by creating a minimum Medicaid income eligibility level across the country.
Financing Beginning in 2014 coverage for the newly eligible adults will be fully funded by the federal government for three years.  It will phase down to 90% by 2020.
Information Technology Systems and Data Policy and financing structure designed to provide states with tools needed to achieve the immediate and substantial investment in information technology systems that is needed in order to ensure that Medicaid systems will be in place in time for the January 1.2014 launch date or the new Affordable Insurance Exchanges as well as the expansion of Medicaid eligibility.
Coordination with Affordable Insurance Exchanges This system enables individuals and families to apply for coverage using a single application and have their eligibility determined for all insurance affordability programs through one simple process.
Benefits People newly eligible for Medicaid will receive a benchmark benefit or benchmark­ equivalent package that includes the minimum essential benefits provided in the Affordable Insurance Exchanges.
Community-Based Long-Term Services and Supports Includes a number of program and funding improvements to help ensure that people can receive long-term care services and supports in their home or the community.
Quality of Care and Delivery Systems Improvements will be made in the quality or care and the manner in which that care is delivered while at the same time reducing costs.
Prevention Promotes prevention, wellness and public health and supports health promotion efforts at the local, state and federal levels.
Children’s Health Insurance Program (CHIP) Extends funding for the Children’s Health Insurance Program (CHIP) through FY 2015 and continues the authority for the program through 2019.
Dual Eligibles A new office will be created within the Centers for Medicare & Medicaid Services to coordinate care for individuals who are eligible for both Medicaid and Medicare (“dual eligibles” or Medicare-Medicaid enrollees)
Provider Payments States will receive 100 percent federal matching funds for the increase in payments.
Program Transparency Promotes transparency about Medicaid policies and programs including establishing meaningful opportunities for public involvement in the development of state and federal Medicaid waivers.
Program Integrity Includes numerous provisions designed to increase program integrity in Medicaid, including terminating providers from Medicaid that have been terminated in other programs, suspending Medicaid payments based on pending investigations or credible allegations of fraud, and preventing inappropriate payment or claims under Medicaid.
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